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o lllr l___n �J�REcrc�o�o2� UPC 12543 -_ No. 53LOR i'h ��.��� �� �� ���.,�f Z/3 d�� 2 �CJO/C .k. !. � J ., .�s-�" I Town of Barnstable . Permit# Fapires 6 mon s from u,,W date Regulatory Services Fee • Mnsa 1639. Richard V.Scali,Director ���' C70 Building Division L om Perry,CBO,Building Commissioner 1- 8A� 200 Main Street,Hyannis,MA 02601 (� Ns' www.town.barnstable.ma us Office: 508-862-4038 '48e 1C Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number PMU L 6 Property Address ���� � C_ , Lie f4 - [Residential Value of Work$ / G Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ZS- IT k 1 Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name�7G`t =�D Workman's Comp.Policy# RE F6,-7 L? Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) [-Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to y 1, OKIZ <gxd xlC ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ 'Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is require . 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CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINTnON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection ro es and r ements and he/she will mply with said procedures and requirements. Signature of Hc&wner Approval of Building Official. Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the.unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fbrms\EXPRFSS.doc Revised 040215 I : ♦ � s 0 Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder I, , as Owner of the subject property hereby authorize to act on ray behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. r j QAWPFIMES\FORMS\building permit forms\02RESS.doc Revised 040215 VDAC In WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (GS60U6-2E86797-5-15) NEW-15 INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY ' NCCI CO CODE: 10456 t. INSURED: PRODUCER: WAGONER, DANIEL A DBA MAGNUS LOVEOUIST MURRAY INS AGC ROOFING & SIDING PO BOX 38 40 GLENEAGLE DR WEST DENNIS MA 02670 CENTERVILLE MA 02632 Insured IS AN INDIVIDUAL Other work places and I ,n"Ic`atlon numbers are-shown In the schedule(s) attached. 2. The policy period Is f 0m 04-17-15 to 04-17-16 2 1 A.M.at the Insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work In each state listed in Rem 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee °= C. OTHER STATES INSURANCE: Part Three of-the policy applies to the states, If any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B V� N� °— D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE o 4. The premium for this policy will be.determined by our Manuals of Rules, Classifications, Rates and Rating �= Plans. All required Information is subject to verffication and change by audit to be made ANNUALLY. DATE OF ISSUE: 05-01-15 NV ST ASSIGN: MA OFFICE: ORLANDO DA HTFD 05G PRODUCER: LOVEOUIST MURRAY INS AGC 75SCH 012824 H F s r°y Town of Barnstable *P�t� �° �(. Expires 6 maul I from is me y�P Regulatory Services Fee EARN BLF� v Mass. � Thomas F. Geiler,Director i639• AlED MAy a Building Division D M Tom Perry, CDO, Building Commissioner I" 200 Main Street,Hyannis,MA 02601 www.town.b arnstab l e.m a.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without.?ed X-Press Imprint Map/parcel Number '0 L.� `"''D I �1 �/) Property Address 7 7C�//��C� J�JGI n ( L'1JE%71n,��4 S rl� 1 l��-t ��6 t Residential Value of WOW,- Gj . O Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name �1, U�L./-,X(ZS Telephone Number q)'F`3-7 "-7/ Home Improvement Contractor License#(if applicable) � 5-6 Construction Supervisor's License# (if applicable) G / T �,,,-�I �• a' lI S 'Low-*-u ❑Workman's Compensation Insurance MAY _ 3 2010 Check one: I am a sole proprietor I am the Homeowner TOWN OF BARNSTABL e ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value 4 (maximum .44)#of windows_ *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. il' A copy o he Home Im rovement Contractors License & Construction Supervisors License is �! require . - / SIGNATURE: I l L ............ .........-,....,. .. _ r_ ._ rvnn run �__ The Commonwealth ofMassachttsetts Department of Industrial Accidents ' Office of Investigations 600 YYashington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r ` ,� Please Print Legibly Name (Business/Organization/Individuai): Y��� M ��l�1/�21�S Address: r)o(7 . (RA�z-F, ujrz_Sl 01A ©d66� City/State/Zip: Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hued the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp.insurance. required.] P 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions r_. ..____rnyself,..[No y✓ork �s.'_cozn ,.... .....____............. . right of exemption per MGL . 12.ORoof.re airs c. insurance required.] t ........... 152, 1 4 , and we.. no p § O employees. [No workers' l3.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year.imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations if the DIA for insurance coverage verification. 1 do hereby c and _ he p ins an . alties o perjury that th in rmation provided ab ve is tru and correct. L pp�� Si nahure: �—'6� � Date: O` /C) Phone#: — 367 ` 7l / Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other IF Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for.their employees. Pursuant to this statute, an eniployee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair.work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the peiformance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s) of . insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees other than the members of partners,are not required to carry workers'compensaiion insuirarice If an LI;C of I;T;l'does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Indiistrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit./license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write "all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia OfIKE Tph Town of Barnstable Regulatory Services 1ARNSTABL- ' Thomas F. Geiler,Director y Masa 4'prf0 3,.IINS Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Pax: 508-790-6230 Property Owner Must Complete and Sign This Section If Usina A Builder I, P as Owner of the subject property hereby authorize &1 lAe-'(:5 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address ofjob) -Apy-L 2-w 1201(� Signa of Owner ate Print e If PropertyOwner is applying for permit please complete the Homeowners License Exemption Form on the.reverse side. i Q:FORMS:OWNERPERMISSION I Town of Barnstable P�oFtKE Teti o Regulatory Services Thomas F. Geiler,Director BARNSIABLE, 9qp Building Division TEDWWIA Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barristable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: s number street .village "HOMEOWNER": name home phone#! work phone ii CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a forrn/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC i � �� �ominzar�euec��i ���Gl«ao��aa • Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration`_',' '165568 Office of Consumer Affairs and Business Regulation Expirat o:n==3721201�2 10 Park Plaza.-Suite 5170 �__=1 Tr# 293967 -=ten Boston,MA 02116 Type:-PFlrrateLC9rporation GRYPHON BUI�DEF 1 � � STEPHEN BRITTQN- 500 MAPLE STREET _ WEST BARNSTABL�E A 02 ��— Undersecretary ' Not valid without sig ature Massachusetts - Department of Public Safety Board of Buildinla Regulations and Standards Construction Supervisor License License: CS 12414 Restricteii to: 00 STEPHEN W BRITTON PO BOX 897/500 MAPLE ST W.BARNSTABLE, MA 02668 i Expiration: 7/21/2011 8Yi3(o7 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - Map Parcel �� Application Health Division '' f Date Issued- �� O Conservation Division `lit// Application Fee - Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address�T, Village Owner 1 Ll,�t 60U& 4 Address Telephone Permit Request EUIL> A 60 DEC4e I� � --T Square feet: 1 st floor:existing proposed 2nd floor:existing proposed _ To vat new - t C=3 Zoning District Flood Plain Groundwater Overlay 1 G / c Project Valuation Construction Type a Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation,. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) - Ln rn Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ - - - Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION NameC��� , Telephone Number'! - Address d �a�Li fitc Q— License# 45O�3 LD, " 5i4) n Q,, our A- Home Improvement Contractor#_ Worker's Compensation# �00( lJ 63g 2� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO &&TA(-6 SIGNATURE . DATE / D • FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. , I ADDRESS s VILLAGE OWNER w , DATE OF INSPECTION: FOUNDATION FRAME :f � INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINALoo 7 , GAS: ROUGH FINAL ' FINAL BUILDING DATE CLOSED OUT. ASSOCIATION PLAN NO. : The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - www.mass.gov/dia Workers'Compensation Insurance:Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): . OA Address: kil l_ City/State/Zip: W RAW- o Phone.#: -36 2—,999 Are you an employer? Check the appropriate box: Type project(required):, 1.VIE a employer with 4. ❑ I am a general contractor and I oyees(full and/or part-time).* have hired the sub-contractors 6. New construction . 2. a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' " #. 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑.Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' . .13.❑ Other comp.insurance required.] . R 'Any applicant that checks box#1 must also M out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below isthepolicy andjob site information. Insurance Company Name: Policy##or Self-ins,Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure_to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains•and penalties of perjury that the information provided abov is true and correct Simature: J Date: 4* 9 Phone 4: Official•use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License.# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I - Information and Instructions, Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the.occupant of the' dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to•operate a business or to construct buildings in the commonwealth for any applicant who has not produced•acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states,'Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships(LLP)with no.employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. "The affidavit should be returned to the city or town that the application for the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city-or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the. applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.. The Department's address,telephone-and fax number:: The Commonwealth of Massachusetts Dopar anent of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-49QG ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.rnass.gov(dia °F ,EZ Town-of Barnstable Regulatory Services BARNSTABM Thomas F.Geiler,Director y MASS. 1639' Buildincr Division �lED MP'�a b Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax; 508-790-6230 Permit no. Date . AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, -improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. {� Type of Work:��ULtU �l �_(� Estimated Cost + Address of Work: 1 � 5� t,)4�2 r w 1 2. Owner's Name: Yam' Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied• ❑Owner pulling own permit Nonce is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES.OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Date Owner's Name Q:forms:homeafndav v Town of Barnstable. Regulatory Services Thomas F.Geller,Director Building Division Tom Perry, Building Commissioner 200 Main'Street, Hyannis,MA 02601 www-town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign. This Section If Using A Builder as Owner of the subject roe J P P riY hereby authorize_ (; to act on my behalf, in all matters relative to work authorized bythis building permit application for; . (Address of Job) -7 -n Signature Vwneu Date Print Name QFOP,R?S:OwNT<RPERMISSION 'BOARD OF BUILDING REGULATIONS £ i License: CONSTRUCTION SUPERVISOR ! Number: CS 4' 005392 Birthdate:, 10/19/1954 Expires: 10/19/2007 Tr. no: 6265.0 Restricted: OQ BRADFORD K HAVEN, :?5 BARNHILL RD BARNSTABLE MA 02668 c /y� d. i - Commissioner 921 'Ccar��cranureal , a �?�aavac�u — Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 104513 Expiration: 7/14/2008 Type: DBA l ,t BRADFORD K.HAVEN CARPENTRY Bradford Haven f..w: 25'Bamhill Road �� - • t W.Barnstable,MA 02668 Deputy Administrator � f {..___-�_ _.+ _� i --j- — --1 ' •i i I � ._j 1 .� I i 1 +. � .. ! �. .j i.' { � '�'�'�� .f 1 ..y +.. ..; _l'.. �. In 77 • ... +„ \� `.� � it i�� ' f+ to". ES, Al TC till r Application to (91b Rina'o 3biabbw Regional Jbiotoric Miotrict (Committee In the Town of Barnstable CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings,or photographs accompanying this application for. o _400 pP CHECK CATEGORIES THAT APPLY: v � 1. Exterior building construction: ❑ New ❑ Addition ❑ Alteration o Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole Other'- p TYPE OR PRINT LEGIBLY: DATE -oAR'-,Q- ADDRESS OF PROPOSED WORK ''L ���� ASSESSOR'S MAP NO.- OWNER Qmq- eiaia2g ASSESSOR'S LOT NO.. 4!Y5"' HOME ADDRESS —TELEPHONE NO. - FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR L� ��� TELEPHONE NO. ADDRESS � y d7f.� KI6• - � 1 � G'r(� OZ�iG DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. 2.4mcrx—er- � �1 �� `7-,Y- J 'v Signed 4ner-(G�on�tractor-A&Jt For Committee Use Only ra h---This Certificate is hereby - Date I' 11 LS I Approved/ ie JUL 0 3 Zp 7 Com ers' Signatures: N T,` 'LE r , Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION SIDING TYPE COLOR CHIMNEY TYPE COLOR ROOF MATERIAL COLOR PITCH WINDOWS COLOR SIZE TRIM COLOR DOORS COLORS SHUTTERS COLORS GUTTERS COLORS irk wu tjti DECKS /Q X MATERIALS I 1 {�s-�� Lcery;i j GARAGE DOORS COLORS SKYLIGHTS SIZE COLORS SIGNS COLOR IJ Jut u L3 �007 T� HIS R " COLO ,,� n•rrARl c FENCE ���b1►j NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of hiss form are required for submittal of an application, along with Four copies of the plot plan, land ca I plan and elevation plans, when applicable. Qj SPECSHT Revised 11/98 a vroperry �bKetctl Legend AS o f 1 I . A`rJ i y .jam r c F Lh t9 a e �1r A. ' ON . el tk �f'T US207 'J" O SUL S 0 , �j BARN TAB VTI01A � � ksBuilt Card N/A s—. r. I 1f `a�ra� r �! bKetcll Legend i------ lilim fi. 9 � ' •������������' � v, ❑ �:t' D ,u. �o �_ r, F �`w7�,,o' y• v, �ti, s. :�'.�f'T WON aft. sip .+.. CjTC) d l5 2J 113A UP : Ilk �� - Y �z �r 3 t En a 5 j �zR. F i PlAl L klK T t -4 I 7 Zkl �� D `'�)& Z-z/Z. 10-154-5 //,(o Aj 14- 5p&,,7 ZX4� _A �j co"c fc e d JX12-4 -4 Tn � �V6 �x xS q3 Assessor's office (1st floor): s; `TNET Assessor's map and lot number . .......... .. ` 1. ...... �o o� Board of Health Ord floor): � d � Sewage Permit number ..+...................... �............ .... ""' "' Z BARNSTABLE, i 1 _ Engineering Department "(3rd floor): _ S, �o ran& House number �S o i639 .................................... ..........:....................... '�o�aY a` Definitive Plan Approved by Planning Board --------------------------------19-------- . APPLICATIONS PROCESSED 8:30-9:30 A.M. and; 1:00-2:00 P.M:. only TOWN, OF BARNSTABLE BUILDING INSPECTOR ��fiM -16�rw- \y , � �s,,w APPLICATION FOR PERMIT TO .A46, - z9AQ kzol'-,...... of &:0trM'& ............................—�J J ........................ TYPE OF CONSTRUCTION ..(aJ........ .......... TO THE INSPECTOR OF BUILDINGS: . The undersigned hereby'applies for a permit according to the following information: Location ..?../.- .... .a `JT�EE G '�......... !I.........-E .lam r ��3 .. Proposed Use oning District ... t...........................................................Fire District GJ` � T�b1=� Nome of Owner .4-4 1- } ....................Address ''lQ.. ..?.??...Ct......;.........I.P4,t7 . W E Nome of Builder / .1�;��.....��.....'/�P�tl.��.�.................Address ..................... . .............................. ......... ............... I Nome of Architect !`JQiVIL.. ..:. 1.. I�ELL ....... �.....Mr�l.!�.. .�......... Address /... Number of Rooms ....O.A(L. ..................................................Foundation ... ........................................ Exterior ... :!.�i. .CD.Q �.e447 ...............Roofing ....Floors Q I ............................................................Interior ... /r�/j„_V.. ........................................................... Heating .......����C�P.. ....... ......... .. .!K�......... ..... .Plumbing ...... . .......................................................... Fireplace ......1�' ............................................................... t w iX-_,e.......Approximate Cost Area .sue.. ............?o�.-.. �... Diagram of Lot and Building with Dimensions Fee ............................ Q OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .: !? ..` ........................................... ` Construction Sup aos 39�- ervisor's License .......... ......................... GENSLER, CARLTON A=108-015 V No ..32U.34. Permit for TO...DWELLING .........&...BU.ILD...GA.RAG.E,/.S.i.n.q.l.e...F.apily Dw. . ..... ....... ..... ....... .. . .. . .. Location 475 Cedar Street ........................................................... ...West...Barxi.s.t.41?.jg.................... Owner ....C.ar.l.to.n...G.e n.s,l e.r....................... .. .... .. .... .. .. .... .. .... .. Type of Construction ......FXAMP........................ ............................................................................... Plot ............................. 'Lot ................................. Permit Granted .....Aqg.la5.t;...I.Q...........19 89 Date of Inspection ....................................19 Date Completed ................... ...................19 X) 7 NV' CW-r) S let- :s q0Q* o9or o7o r e wo vt ir, r. wit-, Assessor's map and lot number Sewage Permit number :: ..... ................ ............. ) " TO N OF BARNSTABLE i 11MMSTdDLE, i �( mum \� VV BUILDING INSPECTOR APPLI6A OR PERMIT TO .. ........... . TYPE OF CONSTRUCTION ....... ... .....:. ....19.....:.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby ap �5- a permit according to the following information: Location .... ......... ......... ... ...... ...... .. ......... ......... ......... ........: ......................................................................... Proposed Use ..... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ......: Address ................................................ . .. ......... ......... ........... ........ ......... :........ ...... ......... ............................ Name of Builder Address ...... :...... ... ........ . ........ .............. Nameof Architect ..............................................Address '.................... .................................................................................... Number of Rooms ....... . .....:::............Foundation ... Exierior .... ................................................ .........Roofing ......: Floors ......... ........ .......:. ::...................Interior ......:'.............. ............................................................... Heating .. .... ::.......................................................Plumbing Fireplace ............ .....................................................................Approximate. Cost ..........::.:.....:.::............................................. Definitive Plan Approved by Planning Board ---------------____-z---------19_____:__. Area Diagram of Lot and Building with Dimensions Fee ............ : .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH R tl a p n i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable_regarding the above construction. Name .... ......... ......... .... ......... ......... ......... a Sea-Lake Corporation A=t09=5- E. 18064 v 1 1 2 story, No ................. Permit for .................................... single family dwelling ............................................................................... edar St t .Location 1. 0 .. .................... ............................... West Barstable ........................................./................................... Owner Sea-Lal/e Corporation-. ........................�. . ................................... Type of Construction .....,,,,,.,frame ................................................................................ Plot . ..... Lot ..............#53 ` ........ .................. November 19 75 Permit Granted ........................................19 Date of Inspection . ::::�.....................19 Date Completed PERMIT! REFUSED /............................ 19 ... .. ..... . ... ....... .. ........ ... ............................. ............... .... .. .. - ALoved .........A ...................................... 19 ilivy6 �/i ............................................................................... e iv Y F 3 - 8 9 m; --- `� 1 :11 i /�_5" �I I�. ,,�.4• 13-01 - 2xB Vi a' V 6ATN i,er( � ` 13E0'PA AD9. 2 o h � 'O va o ... .. ... - 14 /. ':.... _ _ � �1 71 /. N (. I rye— te,;7c 2dx78� - .. . I ro �3-�• - � 2xd Wae:a rl q •'� — TBxiP•�, N W i Ks ID I .. � ,i ,_. .,8.ro';!Z '.,rk/. _ V;�� (_� ��n� ..N 'Grv/.yc�-.t/�� - �pg _ .. � 1- • � � � I: I � �, • � � ' <� u I �. .. �. � _g GxH-t �i N7 u1t N � � ' � I G'Ei arB'yr� 6 :8 a K6 I 1. —6x8Ya�b— 1H/6 I— _ , S6 KBJ• � 6,� 22 0 or. ..59-CEcra/e v "� otr tGuiE4/ ir��s L Pol ,cT QUA►<ER. .H6USE-.`,t OtVaES. SEA 6.AIfE CORPORATIOIJ -P.O ,ab Z64-• SAND\4ICH 1\MA99*64&SEYT9 �i - r •��; A., t r T. t ,. ' &; i ' REYI-ION9r S`CALL't �dr<�tl/ Q dI�WG Lq0 r 5 _ . � C.j,C�-N•.S f G..a nk+E,< ^n,r -:r•,!<r h. r ..."t �.ti. *s., ?: {.y.. ^�.4Y.' r n - ..J• .1.y _ nC b. .w•7r1... a�.3..�w+"�'i�'<aso;:rgteT-c;a.w,�T. ! _....�1....-.mrs.....�..w�. r .t_2., r•�;_f a- �'h '#. .>11 ---�:�s�''eac.,••+�� aC I"ITTTI ' j I '-!TI'll!Ill�illlil;il!i !! i i i . li II1�1111!I!�IFir. �• II ' ill �'i! I -Tllf�'iITII!I!II`_i!��I!II' •'.� ' - :; i I I ! L_li!I!Ill�lil i� I I I j I , /U I•,! i�I�,I,114--i'.'—.I .I-i:'II I, ff I 1 iiili:!!l'I ,II I . i'�III ��I� Ilii '• II I�j�' , ' I Ni p. I i s • 1 j j _ - i I� 1• J � C I t I Rill It i R 0 N L E LJ14) % C) • ,GoT 53- Cc-o�v�e S�, ��2A/bf//E1�1 - wEsT 8.e�ewuTa��F/ M.vss. QUAKER HOUSE HOMES SEA-LAKE CORPORATION P.O.BOX 264 SANDWICH,MASSACHUSETTS REVISIONS: SCALE,�Q�/-O r� DRWO NO. BATE DRAWN:'/-�, OF 5 . ' _ DRWNBYyE'ZVCHKD Yt - 17 -F T ! : riil. I , LLJ _ a u I it�•� I 1�— III` , �< II i i���M� II ur I • 1 ' , I � ' — _ I ICI l , i ! Jl t 11 � r I f i I , I I ; -: il O l I Ii - iI Illil' � . "• -- —�_ I� •s!i � � Lei j I 1—` , �I l ' • • � t I { !i I � i. I'` � � � 'I i i a. �'�;��I��.i•-:L.I. '��ii{ I..�i I i ') '.. � �i� � .. .. � �..�. rr I �— — — — —. _.- -- ------------- - ----t.._._ _.._ I I-- - rr i9 — --� ....... — -- -- — — — -- — — L fj'S i Ej aI<:L -. Sa,Ii,VCGFS. 5 j:l i I _... 4.✓NaTF. aN)LE S-rw ---.. _ �. _I JI . ,'.a .--- - i.I�~-•-�--- -- - _ _.. _ _ ,I I � -_� ,I . • �!; I:_- --- -- ' - �"'III L - _ ,_.._.._.__.. r �l . s p1 I - ..-- -- - - --- .... - .....Itll F L=VA i oilk �s��a- Ca>�a Co P• I .t oT s9-amoaa srzewr �TR.oitvi�" w�ST�A�Asr�e��,Mass. ' ' . ' (�U61KE�t HOUSE HOMES SEA-LAKE CORPORATION " P.O.Box 264 SANDWICH,MASSACHUSETTS . - REVISIONS: $CALEf 'DRWO a - DATE DRAWN- /'/"�Jt - DRWN.BY:y�HKDBYf r I,. M. 7. \r - I •.I L--)I �_-1 f__'li _ _:_ I ' . -I rl i i. !I!: �0 i i" �1.c.51l,tiyces.s� d wI� J ,ram �I f-i I E . ,I ,1 1 I LI , _ _ I 1.(�. - . - --- - ---- - - -• _. ___._ -=- ----- --------- ! L i/,ei C;J QUAKER HOUSE HOMES . SEA-LAICE CORPORATION, :.: P O.BOX 284 SANDWICH,MASSACNUSETTS • - _. -. .-. - - ISI r - J DRiW O NO.CAL ATE DRAWN:7 DRWyCHKDBYo-.'N©Yw ' � -(� -f i$)' e, ,:. � .`;.� � i � -ram: f-q.�� `•{ S f.� y y ,fir. � �� � -I I t I t I I ���I ,.1 , !.�� I \\�•,, '\�! IUI bl � - ,, , m LJ I�)I M L 1 III I i t �,•/ ,�' ,' I 33 , . , I _T_ I I Ir.�hill•!/"�/ I� - 1 f i 4 LA - \ 1 — - Q o o g I , IMF _ ,oNcl' '> • � Y ' OD u 303 a OVz a, 3 Q X W a e I o �V ►� Xw moo: �Nx o Z 3.1 I c I o I . i J? •�J f' � Ci 1 � - 1 oho vl Ilk) Kl I ! i Pp y I j i ma y !, ! I _ It .3 i v Y~ vt 5 , � .LI IN, f � +r k �t � 't � � ;•E, r a �,�:.': t iM � I p } li ! � � � _ f t F � � � �.._. �4 ..i-. - :..e...f. ,,?�.�ty '*syt:n.- _�._.:,:••,ra., i r•-�-`.: �......p.....� r. .k.':�.sec. q�. .-.�'r• :5.,.. 1—:.,-���^ w..G, t ' I' 774— sor's map and lot number .............�. �2..........A�_. SEPTIC SYS E90 'I%,'VjST-W 01. INSTALLED IN CO ILIAI�CE WITH ARTICLE It STATE � '. Sewage- Permit number .........`5.. �...................................... SANITARYCGDF. � IRAN ' °FINE.' TOWN OF BARNSTABLE i B,HB9TODLL' i i639, NABL 039 BUILDING INSPECTOR 900 \0� ft.M Ar. APPLICATION FOR PERMIT TO .............CONSTRUCT....D.WELLING ........... ....................................................................................... TYPEOF CONSTRUCTION .......................k# F................................................................................................... September 19 , ................................................193.5. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..°TRAILVIEW. . "...—..Lot ..53, ..Cedar. ..Street. .,...West..Barnstable ............. ...................................................... ............... . ...... .. ....... ....... ........ .. .... ........ . ......... ...................... . Dwelling ProposedUse ............................................................................................................................................................................. Zoning District Fire District ........................................................................ .............................................................................. Name of Owner ....SEA—IAKE..QORPORATION......................Address ...R?j7.L'F'iAA,r...$eta.4jWjqhj...Ma5.$,........................... ................. ....................... Name of Builder .SEA..—INT—CORPORATIST ...........Address ...F=A..fiA,...$=dWiQh,2W.$.,........................... Name of Architect _�. '....................Address --- Number of Rooms ......Seven att„W)............Foundation ............ ExteriorFrOnt-claPboararFarmerS Porch-used.P#400fing Asphalt Shingles 235 Self-sealing E All else white cedar... hingles Floors Kit & bath vinYlr..all..other-oak ........Interior .....V1..sheetroC]c ....................................................... Heating gas..Wam.alr.......................................................Plumbing ..FVG-...��r.WatPr:.Pl.I?1?1C�[.......................... Fireplace Yes ..................Approximate Cost $40�:0:00:......... V..... Definitive Plan Approved by Planning Board _______JAY_2r__________19.73__ . Are f........ s Diagram of Lot and Building with Dimensions SEE ATTACHED PL40r PLFfN Fee .... + v ....................... ................. SUBJECT TO APPROVAL OF BOARD OF HEALTH , 9 L °6 � y I hereby agree to conform to all the Rules and Regulations of ithe TowLoft rnstable r arding the above construction. Name ................................ . ............................. Sea-Lake Corp. 18064 1 1/2,,story, ................. Permit for .................................... $ipgjq.J�Wily dwelling .. ........................ .......................... L 0 0 Cedar kStreet 'ca4q6........................................................... . .......................Wes Barnstable ............................................ Owner ............. Type of Construction .......... KAM..................... Y ................................................................................. #53 ............................ Lot ................................ Permit Granted .......November...1.9 19 15 .. . ........ . .. Oat .e of Inspection ./0 .. 'T ......19 Date Completed 60�1 ................19 PERMIT REFUSED* ................................................................. 19 ............................................................................... ................................................................................ ....................................... ....................................... ............................................................... Approved ................................................. 19 ............................................................................. ................. .......... .................................................. Assess rs office (1st floor): G SEP=$YAM BUST ME Assessor's map and lot number .�OP�OI�` /.�...... INSTALLED INCOMPLIAN THE. s Board of Health (3rd floor): 5 �Q ♦� Sewage Permit number - .. ENVIC.ODE .....................:........ ........... ...... . . ' ��OH 'BABd9'fADLE, M� Engineering Department (3rd floor): [� e S TO NM& House number �1�v �o'°tE�a3q At' Definitive Plan Approved by Planning Board _______________________________19-------- . APPLICATIONS PROCESSED 8:30'-9:30 A.M. and 1:00.2:00 P.M. only TOWN OF -BARNSTABLE ' BUILDING, INSPECTOR �� � �� , w , a �a,,WG . i�.2o D a►•►� �P la c¢.etc i fi � APPLICATION FOR PERMIT TO .! ...... !� ��-- G� ........................... ............... ........................................................ TYPE OF CONSTRUCTION .W ...0 ...... .........................................................................................:......... ............................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ?5�....� .�....57?�.Ft�T.... I!1.�...3.A ........ .LE ....... :...( .....��3... ............................. 1...... ProposedUse ..I �1.�E,tiJ'i'✓.lL............................................................................................................................................. Zoning District ... . .........................................................:....Fire District (.�` �Jt'� 7J�b ........................................................................ Nome of Owner .0 L�N......C� NISI-.E�...................:.Address .c`Q. J:-?�4RGL.l ...... �',l.l� �. ...al.C!E Name of Builder B.W.. ..................Address �. � �1'1' Name of Architect L-�DA/ L. .•�jAjZ(�C,IEL-L Address ..I...I.F�.....^?J�!N.. r....... :.> ?Q!�it,G�. .............. Numberof Rooms ....0).1 ...................................................Foundation ...410P.I. .................................................... Exterior .. .. ..E?. l..sln. .. ... 0 .. ..............Roofing .... ........................ Floors ....... ............................................................Interior .. j� Heatin bT g ®JTEQQ..................d4k............:.................Plumbing ...................................................................... Fireplace ......h.Z?..................................................:.................Approximate Cost ..3v. O.Cam........................:.... Area i Diagram of Lot and Building with Dimensions Fee '5 / I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and. Regulations of the Town of Barnstable regarding the above construction. y Name / .. Construction Supervisor's. license .(��53./.. GENSLER, CARLTON ADD TO DWELLING o .3.3.1 .4... Permit for .................................... .••.•••.•& BUILD GARAGE/ Single Family Dw. Location ....475• Ce ... dar Street. . . ........................ .. .... .... .. West Barnstable Owner .....Carlton Gensler . . ................................................ Type of Construction .....Frame ................... .. ................................... ........ ` Plot ........... Lot ................................ Permit Granted .•• August • 10, 19 89 Date of Inspection 970 ' Date Completed .......... .....19 f� F�)� rz Application to [ [;[ Q��aU Old Kings Highway Regional Historic District Committee _ in the Town of Barnstable for a 'FEB, � .3, ,�9�• CERTIFICATE OF APPROPRIATENESS - Application Is hereby made, in sate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application.for: CHECK CATEGO ES THAT APPLY: 1. Exterior Building Constructgi: ❑ New Building Addition ❑ Alteration Indicate type of building: CD House ❑• Garage •❑ Commercial ❑ Other 2 Exterior Painting: ❑ 1 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). . TYPE OR PRINT LEGIBLY DATE 7' ADDRESS OF PROPOSED WORK /^ ASSESSORS MAP N0. OWNER (Q)Z L:MPJ r, BENS IL 1JLS l ASSESSORS LOT NO'— HOME ADDRESS TEL NO.. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). AGENT OR CONTRACTOR TEL NO. ADDRESS Z5'3AWaILL . I DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No.8,other side),including . materials to be used, if specifications do not accompany plans. In the case of signs,give locations of existing signs and proposed . locations of new signs. (Attach additional sheet, if necessary). XjCG a.7i4C ,. �j hP� . . Signed . . Space below line for Committee use. Owner-Contractor-Agent Received by Date The Ce 'ficate is� ereby Date Time Y`y��_ -- ' By Approved Ufoo, IMPORTANT: If Certificate Is approved,approval Is subject to the 10 day appeal period provided in the Act. Disapproved ❑ a 4 'Application to ni LSQgQ V t5 Es Old Kings Highway Regional Historic.District Committee in the Town of Barnstable fora �FEB, . 3, on CERTIFICATE OF APPROPRIATENESS - - cc� �. a- Application is hereby made, iri ease, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470. Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans,. drawings or photographs accompanying this application for: CHECK CATEGO ES THAT APPLY: 1. Exterior Building Constructi9b: ❑ New Building Addition Q Alteration- Indicate type of building: El House ❑ Garage -❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). J TYPE OR PRINT LEGIBLY DATE ' r ADDRESS OF PROPOSED WORK 4�� ASSESSORS MAP NO.� OWNER C-0-CMINJ C2ENSL-M ASSESSORS LOT NO. HOME ADDRESS -9%1 RQLt-IE DRIJ f W ESf IFS TEL NO. FULL NAMES AND ADDRESSES.OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). AGENT OR CONTRACTOR TEL NO. ADDRESS 25J✓b1lt..L 1a. ST��ji P DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs,give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). Signed �:- Owner-Contractor-Agent Space below line for Committee use. Received by H.D.C,.' Date. = `� The Ce ficate is ereby — Date Time By Approved Ell" IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. 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